Catatonia is a syndrome of motor dysregulation that is found in as many as 10% of acutely ill psychiatric inpatients. According to the DSM IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision, American Psychiatric Association (2000)) among inpatients with catatonia, 25%-50% of cases occur in association with mood disorders, 10%-15% of cases occur in association with schizophrenia, and the remainder occur in association with other mental disorders such as Obsessive-Compulsive Disorder, Personality Disorders, and Dissociative Disorders. If left untreated, catatonic persons may die of malnutrition and dehydration, or may cause physical harm, including death, to themselves and others.
The most common presentation of catatonia is the retarded—stuporous variety. Catatonic stupor is marked by immobility and a behavior known as waxy flexibility in which the individual can be made to assume bizarre and sometimes painful postures that they will maintain for extended periods of time. Persons experiencing catatonic stupor avoid bathing and grooming, make little or no eye contact with others, may be mute and rigid, and initiate no social behaviors. Besides the possibility of harm and death due to lack of self care, prolonged immobilization during catatonic stupor may lead to life threatening complications such as cachexia (wasting), rhabdomyolysis (muscle destruction), deep venous thrombosis, pulmonary embolism, dehydration, and malnutrition.
Less common, but often more malignant, is the excited—delirious form, sometimes called lethal catatonia, which is characterized by purposeless hyperactivity and violence. The hallmarks of lethal catatonia are acute onset of excitement, delirium, fever, autonomic instability, and catalepsy. The individual may become combative and harm him/herself or others, and in severe end stage cases of excited or lethal catatonia, the person may develop convulsions, coma and even death.
Prompt treatment in the early phases of catatonic states is crucial to obtain a lasting abatement of symptoms. The usual treatments for catatonia include benzodiazapines, supportive care, and electroconvulsive therapy. Unfortunately, the most effective treatments have some disadvantages. For example, when used chronically, benzodiazepines can be addicting, and electroconvulsive therapy remains controversial in its use. Given these drawbacks, there remains a need in the art for a safe, rapid, non-addictive, and effective treatment that can ameliorate the symptoms of catatonia.
Fortunately, the present inventors have determined that glucocorticoid receptor antagonists such as mifepristone are effective agents for the specific treatment of catatonia. Thus the present invention fulfills the need for an effective treatment for the symptoms of catatonia in select patient populations by providing methods of administering glucocorticoid receptor antagonists to treat patients diagnosed with catatonia.